From the *Department of Neurology, University of California, Irvine, CA; †Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA; ‡Department of Public Health Sciences; and §Alberta Centre for Injury Control and Research, School of Public Health, University of Alberta, Alberta, Canada; ¶Centre of Research Expertise in Improved Disability Outcomes (CREIDO), University Health Network Rehabilitation Solutions, Toronto Western Hospital, Toronto, Canada; Departments of Public Health Sciences and Health Policy, Management and Evaluation, University of Toronto, Canada; and ∥Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Canada.
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ArticlePlusClick on the links below to access all the ArticlePlus for this article.Please note that ArticlePlus files may launch a viewer application outside of your web browser.http://links.lww.com/SPINE/A343Most people can expect to experience some degree of neck pain in their lifetime. In many cases, this will amount to nothing more than mild discomfort which does not require treatment and which has no major impact on work or other activities. However, some people will go on to develop prolonged or repetitive episodes of neck pain—sometimes associated with headaches and/or arm pain and, on occasion, more serious neurologic symptoms such as arm weakness, numbness, and/or sensory deficits—which may become persistent and debilitating.Although the individual risk of developing persistent and disabling neck pain is low, the number of affected persons in the general population is of concern. Debilitating neck pain not associated with serious pathology or systemic disease can be very frustrating, both for sufferers and for those who are asked to treat them. Opinions vary widely on what causes neck pain and how best to manage it. Treatment is often not very effective in reducing pain and disability, and the costs to those who pay for care—patients, insurers, governments, and employers—can be high.Opinions on what causes or exacerbates neck pain often depend more on the training and experience of the treating clinician than on any scientific studies or consensus. This can lead to conflict and confusion. For example:People with neck pain, who seek treatment often consult multiple clinicians in some attempt to get relief. They are often willing to consider prolonged or invasive treatment if it is recommended by the clinician they happen to be seeing at the time.Clinicians who treat patients with neck pain often order multiple tests, hoping to uncover a pathologic source for the pain. Findings from these tests may be contradictory. In an effort to help their patients, clinicians may give more credence to those tests which are consistent with a treatment approach they favor, whether or not these tests can be justified by the available evidence.Faced with paying for expensive diagnostic tests and treatments, which seem to be ineffective in reducing symptoms and disability, governments and private payer organizations often become frustrated. This may lead to delays in authorizing reasonable and justifiable patient care or to outright refusal to pay for treatment.Confusion about neck pain typically leads to blaming behavior, as people seek to assign responsibility or fault. Often the blame is assigned to a motor vehicle crash or other event, and sometimes to job-related or leisure activities. If the person with neck pain does not respond to treatment, and particularly when there is no obvious cause for neck pain, assumptions may be made that he or she is not being truthful about the presence and nature of their pain, or is exaggerating symptoms for financial gain.The problem of neck pain and associated disorders is not unique to developed nations. As noted in the preceding preface by Dr. Lars Lidgren, chairman of the International Steering Committee of the Bone and Joint Decade 2000–2010, musculoskeletal injuries related to motor vehicle crashes, industrial mishaps, and armed conflict are becoming a major cause of disability throughout the world. The cost of treatment for musculoskeletal disorders (MSDs), including neck pain, is increasing rapidly and consuming an ever-growing percentage of healthcare resources in both industrialized and developing countries.